Innovating Innovation

Thursday, August 20, 2015

Dr APJ Abdul Kalam was being sworn in as Republic of India’s eleventh President. The hectic activity gave those involved sleepless nights. The plan was almost finalized. The main hurdle in chalking out the swearing in ceremony was but the list of guests. For the 1000-seat Central Hall in the iconic Parliament House is insufficient for the intended invitees. Apart from VVIPs, VIPs, such officials whose presence is but ‘compulsory’, Dr Kalam’s teachers from Madras Institute of Technology and so on, there were four MIPs (MOST IMPORTANT PERSONS) whose presence was to be ensured at all cost. They were: Rev. A G Leonard, priest of the Rameswaram church, Imam Nurul Khuda of the Rameswaram mosque, Pakshi Venkatasubramaniam Sastrigal, chief priest of the Rameswaram temple and ‘Dr. V who started the Aravind Eye Institute’ .

Now, you wonder who on earth this Dr V is; aren’t you? This article is, therefore, solemnly dedicated to Dr V’s introduction. The problem, however, is this: Dr V cannot be introduced without mentioning- not only his infinite and innovative vision but his tireless and selfless efforts in translating the vision into reality thereby benefiting millions around the world, but himself.

Here is Dr V.

Mahatma Gandhi’s 49th birthday was approaching. Just one more day! It was the 1st of October 1918 to be exact, and a baby boy was born to Govindappa Naicker, a well respected contractor, and his wife- Lakshmi in ‘Vandamalapuram’ village, deep down South of India. The boy, their firstborn, who was to be ‘the one and only Dr V of this planet’, was named Govindappa Venkataswami after his father’s. The contractor-parents were further blessed with four more children-two sons and two daughters. The youngest- now Dr. Natchiar was born 22 years after Dr V.

Govindappa Naicker died when Dr V was in medical college and Natchiar was a little girl. Dr V shouldered the family’s burden, and later on, decided not to marry so as to dedicate himself to the care of his youngers. He graduated from the medical college in 1944 and joined the Army as medical officer. The fateful death of his three cousin-sisters and a neighbor lady, hardly 20 years of age, in child birth prompted him to become an obstetrician. However, after serving only for four years, he suffered from rheumatoid arthritis that attacks joints. His dream got shattered. His illness took him to bed for almost two years. ‘All his joints were so badly swollen that he could not sit, stand, or walk. Even the slightest movement resulted in excruciating pain.’ His fingers and toes were twisted. Natchiar was not yet ten years old by then. Many mistook his illness for leprosy, almost labeling him ‘an outcast’. Some restaurants barred his entry. “It was difficult,” recalled Dr V succinctly, “but then you move on” .

The disease, piteously targeted a wrong victim; for Dr V was an ‘Invincible’, an indomitable spirit wearing a mortal form. Having not much choice, he became ‘an ophthalmologist by sheer accident’. He discipled, with amazing success, his twisted fingers to steadily hold ‘eye surgical blades’. He served in a government hospital for twenty years and retired in 1976 at the age of 58.

As soon as his release from government services, Dr V, without waiting for days, started an 11-bedded eye hospital in Madurai. That was in 1976 itself. His brothers, sisters and relatives- even their children supported him. He firmly viewed that about 80% of the blind need not be so. Timely care with innovative system can salvage 80% of them. His brothers, sisters, their children, not sparing even their spouses, worked in unison, to translate the Big Brother’s Dream into reality by remodeling the eye care system in vogue. ‘Aravind Eye Care System’ was born.

Dr V’s principle was that an eye patient will be given treatment as the case demands, no matter whether he can pay his fees or not. If he pays, it’s welcome. If he couldn’t, he is treated free of cost. The payment the patients made is used to treat free patients.

Aravind Eye Hospital in Madurai grows steadily. Amazingly, it doesn’t employ nurses whom we knew as GNM. It’s a ‘nurse-less’ hospital, an innovation by which its services become more effective.

How so?

Girl students, normally from poor families in villages who got less than 80% marks in their 10th or 12th class exams are recruited and trained, for two years, in ‘ophthalmic care’. On successful completion, they are employed in the hospitals and centers, designating them as ‘MLOP’ (Mid Level Ophthalmic Personnel). They perform ophthalmic nursing and related duties.

Why less than 80% marks? That’s an innovative idea the reader is required to quest it out. Roughly 80% of the Aravind employees are females. Why? Reason it out again. Real innovation lies behind that principle. Why not GNMs? Specialized eye care doesn’t need midwifery, psychiatric and/or many other branches of nursing.

Aravind is growing. By now, there are full-fledged, specialized eye hospitals in Madurai, Theni, Tirunelveli, Coimbatore and Pondicherry. Smaller hospitals capable of eye surgeries were further set up in Salem, Dindigul, Tirupur, Tuticorin, Udumalpet. Eye Testing/Checking Centers equipped with qualified technicians and personnel armed with camera, computers, internet, etc. are also set up in many smaller towns while Eye Camps were organized, continuously, in villages. I don’t know the exact total number of beds, as of now, in the hospitals put together. It’s counted in unit of thousands.

It was Saturday, the 22nd November, 2014 in the Primary Eye Care Center, Kariyapatti, a small town. Some eye patients came and were registered. The ‘technician’ examined their eyes, capturing close range with a simple but good digital camera linked with the computer. The monitoring ophthalmologist at the hospital was viewing the eye being examined ‘live’, via internet or ‘video conferencing’ and instructed the technician, via phone, as to which patient should to be send to the main hospital, whom to be given medicines and which others needed glasses. Time taken? The normal Aravind time frame, no exception, no change. How fortunate I was to witness the process live! ‘The spectacle techno-girl’, as I called her, jotted down their eye-power, made glasses for them and issued in an hour. A short visit to the Eye Camp at Aruppukottai the same day was a lifetime experience. Hundreds of such Primary Eye Care Centers and camps have been set up all over the state.

Eye Camp at Aruppukotta

Back to the main hospital, Madurai. Receptionists, MLOPs, doctors and other various technical personnel work in a smooth flow. A patient should have a companion; the hospital insisted. They should register at the Reception Counter. No patient should be told to ‘go to Room No so-n-so’ but be guided to ‘the room’ by an MLOP. The time spent from registration till doctor examining him decided what is to be done falls within 45 minutes.

In this way, Aravind could create a miracle, achieving more than 300,000 eye surgeries in 2003. Let me be more specific. While an eye doctor in other hospitals- be it in India or abroad, operated upon 100 eyes, a doctor in Aravind operated about 1500 eyes. In other words, a doctor in Aravind is fairly equal to 15 doctors elsewhere. That’s the outcome of innovation envisioned by Dr V and achieved by him and his disciples who work from 7:30 am till 7:00 pm, six days a week. Had Dr V’s system is followed all over India; blindness will surely be reduced by 80%.

India misunderstood the saying- ‘old is gold’ and never give up old customs and obsolete traditions. We are averse to innovations. But the West isn’t. While hundreds of the ‘brightest brains’ fly down to the famous Harvard for better education, that school itself flies east bound to Madurai, to learn Aravind’s innovative systems in general and that of Dr V’s vision in particular. By now, Aravind is the learning hub for many universities and business schools around the globe. A host of western eye specialists were so touched by Dr V’s compassion that some of them dedicated their services in Aravind, though attractive salary is out of question. Dr. Fred Munson and his wife- Mary, voluntarily worked in Aravind for 30 years. Dr. Christine Melson arrived in the Aravind in the early 80s and has stayed, involved ever since. Now she is the president of Aravind Eye Foundation, USA.

Aravind’ growth is still accelerating forward amidst a host of ‘speed breakers’. Its needs in terms of buildings, equipments, manpower, finance, training, research, public relations and management are increasing by an arithmetic operation known as multiplication. Where the need is Himalaya se ooncha, Dr V’s vision is stretching, further and higher. It was the year 1998 when I started to believe that man’s inner quality is the best elastic material in the world that no one knows how far it can be stretched. I was right. Dr V is a living proof.

Er. G Srinivasan, Dr V’s younger engineer- brother dedicated his every being in raising the needed buildings. Those in the financial department managed it with innovative, pragmatic economic principles that could not be found in university departments. Eye specialists in the family manned the various departments in the hospitals, training centers, research, teaching and so on. Though no mention has earlier been made, it should be bear in mind that Aravind has its own training center and, way back in 1992, LAICO (Lions Aravind Institute of Community Ophthalmology) was set up as a multi-level, ophthalmic specialization institute. Apart from various short term and lower level personnel training courses, hundreds of students from all over India and also from dozens of countries get their post-graduate ophthalmic training in LAICO. It’s a world class institute.

Aravind also set up a world class research center- Aravind Medical Research Foundation, adjacent to LAICO. All kinds of ophthalmic research, further studies and related subjects are effectively being carried out here.

LAICO bldg and The Research Center bldg in the right (the corner visible)

Modern eye care technique employs a good deal of materials and instruments. Aravind also faced a lot of problems in importing so many materials needed in the system. Not only that it involves a good deal of monetary expenses, it also demands a lot of shopping abroad, a strenuous system of obtaining permission or duty exemptions and so on. Pushed by the need, Aravind set up its own manufacturing unit- ‘Aurolab’ where the requisite items are manufactured. It is located on a very large tract of land outside Madurai city. The surrounding land patches are cultivated, reaping a sizable harvest. The Aurolab workers are housed in the campus, enabling them to work, without interruption, for six days a week. Not only that Aravind is now dependent on Aurolab for all its needs but its surplus products are also exported to 124 countries all over the world, generating revenue.

Aurolab, entrance building.

Dr V now being no more, a memorial building ‘Nithyatha’ came up at a suitably quiet location, not far from Aurolab. It houses a good number of rooms- a meditation room, a tiny library where Dr V’s personal diary books, in original, are kept; a small auditorium with modern facilities takes one on time travel, rewinding the past almost to a century. In that auditorium, I know I was walking side by side with Dr V.

Truly Aravind is an innovative eye care system consisting of super specialty eye hospitals, an eye care system reaching out to the poorest of the poor in rural villages, its own PG training institute that produces world class eye specialist not only for Aravind but also for about fifty per cent of world’s eye patients; a manufacturing unit that produces and supplies a large chunk of world’s eye care needs; a research center where further researches on eye is being carried out. Above all, any person with eye problem coming to Aravind is given treatment as the case demanded, irrespective of the patient’s paying capacity. It could be the only non-government run hospital in the world that provides totally free treatment with no less quality.

A humble 11-beded eye hospital grows into today’s ‘Aravind’. Its financial transaction crosses the million mark, the crore mark and then the billion mark, now managing a multi-billion financial accounts.

That is, in short; how Dr V innovated innovation. Aravind is not a project that took a century to grow. It’s not a project that a certain genius achieves in a lifetime. It’s the post-retirement project of Dr V. The hospitals, research center, institution, manufacturing unit and rural eye care systems came up in Dr V’s lifetime.

Dr V, some of Aravind personnel and the Aravind itself received various awards and recognitions including, recently, the Antonio Champalimaud Vision Award (2007), The Gates Award for Health (2008), the Conrad N. Hilton Humanitarian Prize (2010). One the other hand, however, Dr V and his siblings always displayed a living example of humbleness and simplicity.

That’s, in brief, Dr V and the Aravind. I am persuaded that it requires a much more eloquent pen than mine to do justice to its story. I humbly prostrate before the living spirit of Dr V, his living disciples and all those in the Aravind, begging their pardon for using my blunt pen on them.

Dr V was ‘Requiescat In Pace’ on the 7th of July, 2006, at the age of 88, in Madurai. How I wish him to be with us, at least, till October end, 2018!

Though Dr V is no more here in his frail mortal form, his invincible spirit lives on, giving a fault-free guide to Aravind in all its upcoming endeavors. He will enable the Aravind to spread its wings wider so that the million poor Indians not only get freedom from ‘uncalled for blindness’ but also set an example in ‘innovating innovations’.